11/4/2019

Objectives
To evaluate the current application of equipment, resources, and
“Care of the CV Surgery Patient: cognitive recognition required in today’s fast paced high acuity
cardiovascular ICU’s.
A Nursing Perspective” To review current nursing practice techniques utilized in providing
nursing care to the complex cardiovascular patient.
To review critical thinking techniques utilized by the cardiovascular
Registered Nurse and cardiovascular Surgeon in order to provide
optimum bedside care.
EMIL HURIANI

Heart and Vascular Critical Care

Procedures Procedures
• Carotid artery surgery
• Coronary artery bypass grafting (CABG) • Aortic aneurysm repair
◦ -On and off pump
• Vascular bypass
• Minimally invasive CABG, including endoscopic
• Lung resection
vein harvesting
• Video-assisted thorascopic surgery (VATS)
• Valve repair, valve replacement

Interdisciplinary Team Preoperative Teaching

It takes an Army Extremely Important!
• CV Surgeon
• Use of heart pillow
• Anesthesiologist
• Waking up from anesthesia on ventilator
• Circulating RN
• Incentive Spirometer
• CVICU RN (2 if post CABG/valve)
• Chest tubes
• RRT
• Expectations of progress (line and tube removal, step-down unit and
• Any other hospital personnel that may be passing by discharge)

TEACHING MUST BE GIVEN TO PATIENT

WHILE FAMILY MEMBER IS PRESENT!

1
 11/4/2019

Postoperative Patient
Postoperative Patient
• Ventilator • PacingWires
• Portable Chest X-Ray • Swan Ganz • SVO2 reflects the amount of O2 not consumed by
• EKG • Arterial line
the tissues and given an indication of balance
between O2 delivery and O2 consumption. A
• LAB (CBC, CMP, • PacingWires
decrease in SVO2 indicates and inadequacy of
MAG, PHOS, PT, • Swan Ganz oxygen delivery and cardiac output
PTT, Fibrinogen, • Arterial line
• Cardiac output (CO) = stroke volume (SV) x heart
ABG, Mixed venous)
rate (HR)
• Monitor chest tube
and urine output

Medications Dealing With Stress

• Vasopressin • Teamwork
• Neosynephrine • Ask for help
• Norepinephrine • Manager Support
• Dopamine
• Use your resources
• Dobutamine
• Vent to your co-workers
• Epinephrine
• Make the workplace tolerable
• Primacor
Volume Expanders
• Albumin
• Hespan